Survivorship care and breast and cervical cancer screening.
Authors: Marco Santos Teles, Ganesh Modugu, Isabel C. Silva, Malcolm David Mattes, Mariam F. Eskander
Journal: Journal of Clinical Oncology (2023)

12075 Background: Studies suggest that despite their history, cancer survivors may be equally or less likely to be screened for various cancers. The impact of the components of survivorship care on post-treatment screening is unknown. We aim to gauge the association of receipt of treatment summaries, follow-up care instructions (including where to obtain “routine cancer check-ups”), and type of doctor providing survivorship care on breast cancer screening (BCS) and cervical cancer screening (CCS) in female cancer survivors. Methods: A cross-sectional, retrospective analysis using Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2016 and 2018 was conducted. BCS-eligible women were aged 40-74; CCS-eligible women were 30-64. BCS completion was defined as a mammogram within 2 years and CCS completion as a pap smear within 3 years or an HPV test within 5 years. Univariate analysis was conducted using chi-square. Multivariate logistic regression was used to determine which survivorship care factors were associated with BCS and CCS. Results: 4,533 BCS and 2,566 CCS-eligible survivors were identified. In the BCS-eligible group, 85.9% were aged ≥50, 89.7% were white, 62.5% had a degree beyond high school, 48.7% earned ≤$50,000, and 96.1% were insured. In the CCS-eligible group, 68.1% were aged ≥50, 87.9% were white, 63.7% had a degree beyond high school, 45.0% earned ≤$50,000, and 93.3% were insured. 82.0% were up-to-date (UTD) with BCS; 92.6% were UTD with CCS. BCS and CCS were higher for insured survivors (82.2% vs. 66.2%, p = 0.009; 93.8% vs. 83.3%, p = 0.013, respectively). 48.7% of BCS-eligible and 50.5% of CCS-eligible survivors received a treatment summary. 75% of BCS-eligible and 77% of CCS-eligible survivors received follow-up instructions. Among BCS-eligible survivors, recipients of treatment summaries and follow-up instructions were significantly more UTD with BCS than non-recipients (84.9% vs. 78.5% and 84.5% vs. 74.3%, respectively, p &lt; 0.001). Among CCS-eligible survivors, recipients of follow-up instructions were significantly more UTD with CCS (94.5% vs. 88.9%, p = .021); there was no significant difference for recipients of treatment summaries (p = .201). In both groups, there was no significant difference in BCS or CCS based on the type of physician providing survivorship care (p = .732 and p = .098, respectively). On multivariate analysis, receipt of follow-up instructions was the only factor significantly associated with BCS (OR 1.46; 95% CI: 1.05–2.03) and CCS (OR 2.57; 95% CI: 1.19–5.55). Conclusions: Follow-up instructions, which are part of the survivorship plan, have the greatest association with BCS and CCS among cancer survivors. Despite this, about 25% of BCS and CCS-eligible cancer survivors did not receive them. Additional research should focus on improving the practice of survivorship care, particularly follow-up instructions, as a method to increase uptake of BCS and CCS among cancer survivors.